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The Root of the Problem: Addiction and Dental Issues

Anyone whose life has been touched by addiction knows that the effects of the disease aren’t confined to the immediate impacts of the drug alone. Rather, addiction takes hold of and fundamentally changes every aspect of your life: mind, spirit, and, of course, body.

While addiction may wreak havoc on the internal systems and structures of the body, those effects are often less readily apparent until significant damage has been done. When it comes to oral health, however, the signs of addiction aren’t just more obvious, but they also can appear more rapidly. Indeed, the connection between addiction and dental problems is so significant that clinicians are increasingly looking for signs of drug and alcohol dependency in the patient’s smile (1). But what, exactly, is the link between addiction and dental problems?

Periodontal Disease

A mounting body of evidence indicates that the prolonged use of illicit drugs is a significant risk factor for the development of severe periodontal disease (2). Indeed, as rates of methamphetamine addiction soared in recent years, the “meth mouth” stereotype became a cultural commonplace, referring to the devastating effects of the drug on oral health. Though the most obvious signs of “meth mouth” are often tooth decay and tooth loss, these problems often originate in the gums and other underlying structures which support and nourish the tooth (3).

However, it isn’t only illicit drug use that can lead to severe periodontal disease. One of the most harmful substances for your periodontal health is, perhaps not surprisingly, tobacco (4, 5). Though all forms of tobacco increase the risk of gum disease, the risks associated with smokeless tobacco are particularly high, presumably due to chronic, direct exposure of oral soft tissues to the tobacco (6).

Despite the significant correlation between substance abuse and periodontal disease, however, the exact nature of the link is still largely understood. What is known, though, is that most addictive substances, from alcohol to tobacco to opioids can produce substantial inflammatory effects, which, over time, cause significant, harmful changes to the body’s soft tissues. 

Tooth Decay and Tooth Loss

In addition to contributing to periodontal disease, substance abuse also increases the risk of tooth decay and tooth loss.  As has been shown, much of this can be attributed to underlying gum diseases. It’s sort of like planting a garden. Your roses will never be lush and beautiful if the soil nourishing them and the ground supporting them are not healthy and strong.

But it’s not only periodontal disease that can lead to problems with your teeth.  Drugs, alcohol, and tobacco are laden with chemicals, many of which may be unknown, and these chemicals can wage a violent assault on your teeth. These ingredients, for instance, can both break down tooth enamel and damage the inner surfaces of the tooth, such as the dentin. As the protective layers of the tooth begin to wear down through chronic chemical exposure, not only do dental caries (cavities) develop, but the teeth also begin to soften, leading to tooth failure. Eventually, the erosion of the tooth, combined with the effects of the disease of the underlying periodontium, leads to breakage and, ultimately, to tooth loss.

Oral Cancer

To be sure, periodontal disease and tooth decay can be devastating complications of addiction. However, perhaps the most frightening and dangerous oral health complication is the increased risk of malignancy. Persistent and repeated damage to the teeth and gums, from chronic infections to gum lesions, can significantly increase the risk of developing oral cancers in these vulnerable areas (8, 9).

In addition to the correlation between oral infections, periodontal disease, and the risk of cancer, the same chemicals that cause gum disease, tooth decay, and oral infections are also often highly carcinogenic. A particularly poignant example, of course, is the myriad cancer-causing agents found in tobacco (4, 5, 6, 7).  Studies increasingly show, however, that it’s not only tobacco that can contain highly carcinogenic agents. Moderate to heavy drinking, for instance, has been correlated to the development of malignancies of the oral cavity (10).

Illicit drugs, particularly crack/cocaine, may also contribute to the development of oral cancer, although the evidence is currently not as strong as that which indicates a correlation between alcohol or smoking and oral cancer (11). Nevertheless, this dearth of evidence should not necessarily be taken as proof that such a correlation does not exist, only that the correlation may have been relatively little studied when compared to the oral cancer risk associated with alcohol and tobacco. Indeed, though studies showing a relationship between illicit drugs and oral cancers are scant, they do exist (11) and appear credible, suggesting a need not only for further study but for significant precautions in regard to oral cancer screenings for those facing drug dependency.

Oral Hygiene and Self-Care

As significant as the relationship between dental problems and addiction may be, it’s not only the physiological impacts of chronic exposure that matter. To say that addiction is an all-encompassing disorder is not news, but it is significant when it comes to understanding how dental problems and addiction connect. Dependency doesn’t just wreak havoc on your body and mind, but it also profoundly and inevitably impacts both your lifestyle and your sense of self.

Thus, those who are experiencing addiction often are unable, and even unwilling, to practice good dental hygiene (12, 13, 14). Their addiction may cause them to miss dental appointments, skip cleanings and screenings, and even to avoid care when problems arise due to feelings of shame or to the fear of the addiction being discovered.

Likewise, those facing addiction may simply lose the motivation to practice self-care. When persons with addiction internalize the stigma of addiction, this can result in the adoption of an identity of addiction (15). Once you’ve internalized such a negative self-image, it can feel nearly impossible to embrace such self-nurturing behaviors as seeking routine dental care and practicing good oral hygiene.

 

How Bayshore Can Help

If you or someone you love is facing dental problems related to substance dependency, Bayshore can help. Our team of dedicated experts is committed to providing whole-person care. That means that not only do we treat the addiction, but we also strive to connect you with the resources you need to live the happy, healthy life you deserve. This includes helping our clients develop healthy habits while with us and become established with qualified oral healthcare providers to address any dental issues they may be experiencing. Reach out to us today to discuss how Bayshore’s caring professionals can help you or someone you love!

At Bayshore Retreat we have extensive knowledge in treating substance abuse and co-occurring mental health issues. We understand that Mental Health Disorders can be the root cause of substance abuse. We use the latest scientific research and holistic approach for drug and alcohol addiction treatment.

References:

  1. Teoh, L., Moses, G., & McCullough, M. J. (2019). Oral manifestations of illicit drug use. Australian dental journal, 64(3), 213–222. https://doi.org/10.1111/adj.1270
  2. Saini, G. K., Gupta, N. D., & Prabhat, K. C. (2013). Drug addiction and periodontal diseases. Journal of Indian Society of Periodontology, 17(5), 587–591. https://doi.org/10.4103/0972-124X.119277
  3. Yazdanian, M., Armoon, B., Noroozi, A., Mohammadi, R., Bayat, A. H., Ahounbar, E., Higgs, P., Nasab, H. S., Bayani, A., & Hemmat, M. (2020). Dental caries and periodontal disease among people who use drugs: a systematic review and meta-analysis. BMC oral health, 20(1), 44. https://doi.org/10.1186/s12903-020-1010-3
  4. Zhang, Y., He, J., He, B., Huang, R., & Li, M. (2019). Effect of tobacco on periodontal disease and oral cancer. Tobacco induced diseases, 17, 40. https://doi.org/10.18332/tid/106187
  5. Sham, A. S., Cheung, L. K., Jin, L. J., & Corbet, E. F. (2003). The effects of tobacco use on oral health. Hong Kong medical journal = Xianggang yi xue za zhi, 9(4), 271–277.
  6. Ebbert, J. O., Elrashidi, M. Y., & Stead, L. F. (2015). Interventions for smokeless tobacco use cessation. The Cochrane database of systematic reviews, 2015(10), CD004306. https://doi.org/10.1002/14651858.CD004306.pub5
  7. Sujatha, D., Hebbar, P. B., & Pai, A. (2012). Prevalence and correlation of oral lesions among tobacco smokers, tobacco chewers, areca nut and alcohol users. Asian Pacific journal of cancer prevention : APJCP, 13(4), 1633–1637. https://doi.org/10.7314/apjcp.2012.13.4.1633
  8. Surtel, A., Klepacz, R., & Wysokińska-Miszczuk, J. (2014). Następstwa uzależnienia od alkoholuobserwowane w jamie ustnej [Alcohol dependence syndrome–symptoms in the oral cavity]. Postepy higieny i medycyny doswiadczalnej (Online), 68, 828–833. https://doi.org/10.5604/17322693.1109192
  9. Zhang, Y., He, J., He, B., Huang, R., & Li, M. (2019). Effect of tobacco on periodontal disease and oral cancer. Tobacco induced diseases, 17, 40. https://doi.org/10.18332/tid/106187
  10. de Menezes, R. F., Bergmann, A., & Thuler, L. C. (2013). Alcohol consumption and risk of cancer: a systematic literature review. Asian Pacific journal of cancer prevention : APJCP, 14(9), 4965–4972. https://doi.org/10.7314/apjcp.2013.14.9.4965
  11.  Sordi, M. B., Massochin, R. C., Camargo, A. R., Lemos, T., & Munhoz, E. A. (2017). Oral health assessment for users of marijuana and cocaine/crack substances. Brazilian oral research, 31, e102. https://doi.org/10.1590/1807-3107BOR-2017.vol31.0102
  12. Hewson, V., & Wray, J. (2012). Are the dental health needs of adults with illegal drug dependence being met by current service provision in the United Kingdom?: a literature review. Journal of addictions nursing, 23(3), 191–199. https://doi.org/10.1097/JAN.0b013e31826f4bf2
  13. Shekarchizadeh, H., Khami, M. R., Mohebbi, S. Z., Ekhtiari, H., & Virtanen, J. I. (2013). Oral Health of Drug Abusers: A Review of Health Effects and Care. Iranian journal of public health, 42(9), 929–940.
  14. Pourhashemi, S. J., Ghane, M., Shekarchizadeh, H., & Jafari, A. (2015). Oral health determinants among female addicts in Iran. Contemporary clinical dentistry, 6(3), 375–380. https://doi.org/10.4103/0976-237X.161893
  15. Hughes K. (2007). Migrating identities: the relational constitution of drug use and addiction. Sociology of health & illness, 29(5), 673–691.
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